Provider Demographics
NPI:1609817923
Name:KOBB, MARK EVERETT (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EVERETT
Last Name:KOBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E BRINGHURST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1719
Mailing Address - Country:US
Mailing Address - Phone:215-844-1020
Mailing Address - Fax:215-844-2702
Practice Address - Street 1:251 E BRINGHURST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1719
Practice Address - Country:US
Practice Address - Phone:215-844-1020
Practice Address - Fax:215-844-2702
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038587E207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE64131Medicare UPIN